COVID-related inflammatory syndrome hits poorer, minority kids harder

Multisystem inflammatory syndrome in children (MIS-C), which has been linked with pediatric COVID-19, may pose higher risks to children in lower socioeconomic statuses or who are minorities, according to a Pediatrics study today.

The study compared MIS-C patients with those who had COVID-19, those who were evaluated for MIS-C but found without, children with febrile illness, children with Kawasaki disease, and healthy children in the state. Everyone included in the cohort was under 21 years and in Massachusetts.

In total, 43 patients had MIS-C. Most (58.1%) were boys and of non-White racial or ethnic descent (44.2% Hispanic, 25.6% Black). The median age was 9.7 years at diagnosis. About two thirds (67.4%) of children with MIS-C had a positive antibody test for COVID-19, and 19 (44.2%) had preexisting comorbidities, with the most common being obesity (17) and asthma (6).

A little more than half of MIS-C patients were in the lowest socioeconomic status (SES) quartile (51.1%) or in the highest social vulnerability index (SVI) quartile (53.5%). The researchers calculated that, compared with the general Massachusetts population, both groups had more than double the risk of MIS-C (SES OR, 2.2; 95% confidence interval [CI], 1.1 to 4.4, and SVI OR, 2.8; 95% CI, 1.5 to 4.1). SES and SVI values were similar between the MIS-C and COVID-19 groups, but patients in the other groups tended to have higher household income.

Black and Hispanic children were independently associated with greater risk. The researchers report that children in the lowest SES quartile who were Black had between an 8.7- and 10.8-fold higher risk of MIS-C compared with White, non-Hisptanic children in the same neighborhood. In the same SES group, Hispanics of any race had an OR of 8.7 to 49.8.

"Steps to ameliorate risk for exposure to COVID-19 are key to limiting incidence of MIS-C," write the researchers. "Identifying neighborhoods in which children are most likely to have COVID-19 exposure can inform public health efforts and may allow for proactive protection of at-risk populations."
Apr 28 Pediatrics study

Pediatric hospitalizations for any cause fell from March to August 2020

All-cause weekly pediatric hospitalizations in the United States decreased 48.3% in the spring and 23.5% in the summer 2020 pandemic months when compared with the median volumes in 2017 to 2019, according to a JAMA research letter yesterday.

The researchers looked at 1,699,911 pediatric hospital admissions from 42 freestanding children's hospitals and found that the weekly median dropped from 12,830 in spring 2017 to 2019 to 7,033 in 2020 and from 11,697 in summer 2017 to 2019 to 9,178 in 2020. Decreases in hospitalizations occurred in all demographics and clinical subgroups.

The smallest percentage change per week was in summer 2020 among teenagers 15 to 18 years (-9.6%), and the largest was among children with low illness severity in spring 2020 (-56.4%). Regarding condition-specific hospitalizations, the largest decrease was found in patients with respiratory failure during spring 2020 (a 2017-19 median of 296, dropping down to 87 in 2020; -167.7%).

The researchers also note that the smallest percentage change per week was in summer 2020 for diabetic ketoacidosis (-0.7% from 2017-19 to 2020), though the change was statistically insignificant. Suicide/intentional injury was the only cause of hospitalization that increased in summer 2020 compared with previous years (+11.8% from 2017-19 to 2020), but that change was likewise not statistically significant. 

Potential reasons for the lower hospitalization numbers could be due to social distancing and higher symptom monitoring in children, the researchers conclude.
Apr 27 JAMA study

Study finds low uptake of HPV vaccine in young US men

A research letter yesterday in JAMA shows that less than 20% of US men 18 to 21 years old have had at least one dose of the human papillomavirus (HPV) vaccine.

The study, conducted by researchers at the University of Michigan, was based on data collected during the 2010 through 2018 National Health Interview Surveys. Only 16.2% of men ages 18 to 21 during any year of the survey said they had received one or more doses of the HPV vaccine, compared with 42% of women in that age-group.

Among the young men who did receive at least one dose by the ages of 18 to 21, 29% completed the vaccination series. The percentage of young men receiving one dose increased from 2% in 2010 to 34% in 2018, while in women it increased from 32% to 55%.

The Advisory Committee on Immunization Practice (ACIP) recommends that American boys and girls ages 11 to 12 receive two doses of the vaccine, with a third catch-up dose given by the age of 26 if the vaccination series starts after the age of 15.

The Food and Drug Administration (FDA) approved HPV vaccines for females and males in 2006 and 2009, respectively. Last year the FDA expanded the indication to include protection against oropharyngeal cancer. That cancer, which can affect the throat, tonsils, or back of the tongue, has surpassed cervical cancer as the leading cancer caused by HPV, and 80% of cases are detected in men.

"I don't think that a lot of people, both providers and patients, are aware that this vaccine is actually a cancer-prevention vaccine for men as well as women," said Michelle Chen, MD, the lead author of the study and a clinical lecturer at the University of Michigan, in a university press release. "But HPV-associated oropharyngeal cancer can impact anyone—and there's no good screening for it, which makes vaccination even more important."
Apr 27 JAMA research letter
Apr 27 University of Michigan press release